I presume you have seen the story on the news that Angelina Jolie elected to have both breasts removed as a cancer prevention tactic because her mother died early of cancer. I found it quite shocking, did you?
I still don’t quite know what I think about it. It’s not exactly new since women have been having elective surgery for a good few years now; it’s just that Angelina is so high profile, I do wonder what message that is going to send out. Not that that has any bearing on her choices: it is entirely up to her what she does with her own body, but the media coverage is bound to have an effect. Will it make it seem like a viable choice to more women, or shock more than it encourages? Time will tell. It should spark some debate anyway, and that is always a good thing in medicine.
In Angelina’s shoes, what would I have done? I have no idea and I hope I never have to think about it that deeply. It saddens me to think that many women – and men – do have to face that decision every day.
My over-riding worry about it is that she made the decision based on the presence of the BRAC genes. Most experts now agree that it is not the presence of genes related to various illnesses that is the problem; it is what triggers them.
Just because you have the genes, it does not mean you will get the disease. We know that most of the triggers are emotional, infectious, viral, environmental etc so you would have to agree that leading a preventative lifestyle would potentially be a good way of avoiding triggering any genetic illness you were predisposed to. And that is precisely what the detractors of preventative mastectomies say: you could have prevented it, this is a step too far etc etc. They might be right, but whose to say that the worry of getting cancer might not end up being a contributory cause of cancer in the end anyway? An interesting point.
Professionally, I have been able to offer gene and BRAC testing for quite some time, but have chosen not to for loads of different reasons, not least because I don’t think we yet fully understand genetic illness. And, have you thought what that knowledge might do to you emotionally or even to your life assurance premiums!
In my opinion, we are a LONG way off understanding our genes and the way they are expressed, although we are learning at an exponential rate. Genes have so-called polymorphisms, for a start. This means that there are loads of different ‘types’ if you like of the BRAC gene and some have been found to be protective against cancer and others not so protective. I assume Angelina’s doctors could distinguish between the types she had in order to be able to give her a percentage risk.
Anyway, enough of my musings. Here is an interesting piece on it from GreenMedInfo for you:
Also, here is their Breast Cancer Guide with loads of links to researched articles in case this is something you want to read up on.
Did she do the right thing, then? In the end, it is nobody’s business but her own. But it will be interesting to see what happens as a result of all the media stories.
I am bound to see other articles on this subject and I will pass on links to any I think you might find useful, as always. Meantime, I wish Angelina and her family speedy healing and a life less worried.